Should e-cigarettes be banned in India? Experts are divided

The website for Eon, an electronic cigarette manufactured by ITC Limited, shows a woman stylishly blowing out vapour. The product description says that the e-cigarette (or e-vape, for the hip crowd) “gives you the pleasure of smoking anytime, anywhere”.

The e-cigarette is a battery-operated device that contains nicotine. Resembling a cigarette, it is often marketed as a device that helps smokers quit. The person inhaling it will purportedly only consume nicotine vapour minus the 6,000- odd carcinogenic chemicals found in cigarettes and other tobacco products.

However, opinion on e-cigarettes is divided in the tobacco-control community the world over.

In India, where the e-cigarette business is growing, some states have made efforts to ban the device. Last month, the Karnataka government banned the manufacture, distribution, advertisement and sale of e-cigarettes. Earlier this month, the Kerala government issued orders to ban e-cigarettes in the state.

However, efforts to regulate the industry are yet to yield results.

Regulation problem

In fact, there are no laws governing the e-cigarette industry in India.

Since the device does not come under the Cigarette and Other Tobacco Products Act, companies can casually bypass important provisions for tobacco control in the country. These include prohibitions on promoting a tobacco product, smoking tobacco in public and selling it to those under 18 and the mandatory pictorial warning on such products.

When Scroll.in asked ITC if it had sought the approval of the drug controller general before launching Eon, Nazeeb Arif, Executive Vice-President and Head of Corporate Communications for the company, said that this was not mandated by law as e-cigarettes do not come under the purview of Drugs and Cosmetics Act.

Meanwhile, GN Singh, Drug Controller General, India, said that e-cigarettes are "not safe for public health", but they do not "fall directly under either drug or device”. His department cannot take a call on banning e-cigarettes, he said: such a decision can be taken by the Ministry of Health and Family Welfare.

A senior health ministry official said that his colleagues had supported a ban on the device and had forwarded the proposal to the department that handles food and drug administration two years ago, but there has been no further development. “The states also have the powers to ban such products and they are using it clearly,” the official said.

Apart from Kerala and Karnataka, the Food and Drug Administration departments of Punjab and Chandigarh, as well as Maharashtra, have notified e-cigarettes as illegal since they do not have the clearance of the Drugs Controller General of India. In April, a shopkeeper in Chandigarh was sentenced to three years in jail for selling e-cigarettes.

In 2013, Dr Harsh Vardhan, who was Union health minister at the time, called a meeting with public health experts, tobacco control activists, Central Board of Excise and Customs, and the Food and Drug Administration. At the meeting, a consensus was reached on banning the manufacture, sale, distribution, import and trade of e-cigarettes in the country. But the plan has gone into cold storage.

The sale of e-cigarettes has been banned in 13 of the 59 countries that regulate them.

A smoking-cessation device?

There is no consensus in the tobacco control community over the e-cigarette. While some say it helps people quit smoking and are therefore harm-reducing, others view it as a nicotine- delivery product that is addictive and potentially harmful.

Recently, a study by the Royal College of Physicians in the UK stated the benefits far outweighed potential harms.

However, a 2014 World Health Organisation report states that the health benefits of the product are not proven and it should therefore be regulated the way tobacco products are.

To begin with, it has not yet been proven that e-cigarettes actually help cut down on smoking. The WHO report said e-cigarettes do not merely produce “water vapour” as is claimed. The report says that electronic nicotine delivery devices can pose serious hazards for adolescents, pregnant women and women of reproductive age as there is evidence that nicotine exposure can impact brain development of foetuses and adolescents.

E-cigarettes also pose the threat of nicotine poisoning. “If you inhale three cartridges in a row, you can die,” said Dr Pankaj Chaturvedi, a head and neck surgeon from the Tata Memorial Hospital who is also a tobacco control activist. “One cartridge has 11 milligrams of nicotine, and three would contain 30, which can be fatal.”

According to the WHO report, incidents of nicotine poisoning have increased in the US and UK with the rise in popularity of e-cigarettes.

According to recent data, calls to poison centres pertaining to e-cigarettes had increased manifold between 2011 and 2014, said the Centers for Disease Control and Prevention in the US. Of these, more than half the calls involved children below the age of five.

The claim that it is safe to inhale e-cigarettes in the company of others was also refuted by the WHO report. The report said that bystanders are exposed to the aerosol exhaled by users, which increases the background level of toxicants and other ultrafine particles in the air.

Many places in the US and Canada have imposed restrictions on vaping – inhaling vapours from e-cigarettes – in public.

Growing popularity

While there is no global data on the use of electronic nicotine delivery systems, numbers from North America, the European Union and the Republic of Korea indicate that the use of e-cigarettes use of such devices has at least doubled among adults as well as adolescents from 2008 to 2012, said that World Health Organisation report.

Recognising this as a growing market, tobacco companies the world over have forayed into e-cigarette manufacturing.

In India, ITC started producing e-cigarettes in 2014. A few imported products from China are also in the Indian market.

“The current trend is that while tobacco is being dumped on the low-and-middle income countries where the control is less stringent, e-cigarettes are being dumped on high-income countries,” said Dr K Srinath Reddy, from Public Health Foundation of India, who was also part of the group consulted by the Ministry of Health in 2013.

According to Dr Reddy, the fact that tobacco companies are entering into the e-cigarette business is significant. “The companies are surely not looking to promote tobacco- cessation products which are really successful,” he said. “They may be criminal, but not stupid.”

Bypassing laws related to tobacco control

Many tobacco-control activists believe that the e-cigarette business is being used to draw more people towards regular cigarettes.

“E-cigarettes can be sold rampantly in medical shops, sandwich corners, bakeries, and other kinds of petty shops,” said Dr Vishal Rao, member of High Powered Committee on Tobacco Control, Karnataka state. “On the other hand, the law does not allow tobacco companies to attract youngsters. Youngsters are the new consumers and the business entirely runs on them. The new strategy is to introduce new addiction.”

The WHO report also addresses the possibility that children will be initiated to nicotine use through e-cigarettes and once addicted, they will switch to smoking.

“The thing is, even if you remove 6,000-odd chemicals from tobacco, it will not affect the industry,” said Dr Rao. “But if we remove nicotine, the entire business will collapse,” said Dr Rao.

About 70 years ago, cigarettes entered the market without much scrutiny. “If cigarettes were known to be so harmful back then, they would never have been licensed,” said Dr Reddy. “We are now far more precautious. The newer products will have to go through greater scrutiny.”